Payer-Provider Collaboration in an Uncertain Environment

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There is a lot of uncertainty in healthcare today. Health plans like to know what the risk is and manage the risk. And when that risk is uncertain, it is challenging to run your business in that environment.

Many plans saw a drop in claims in 2020. However, the low level of claims will not continue indefinitely. Now, health plans must prepare for what is coming. Yet, uncertainty remains. It is still unclear how many people put off routine visits, as well as emergency care, and how that will impact healthcare costs post-COVID.

In the Annual Payer Index Survey: 2020 Report from Altruista Health, a HealthEdge company, the majority of the 177 respondents cited improving member outcomes as the top care management priority. And when asked about the effects they see with members who delayed medical care, “Forty-two percent reported member lapses in care for chronic conditions, and 26 percent saw preventable poor outcomes due to lack of routine screenings.” 

Should health plans prepare for an influx of treatment? Will costs go higher than expected due to more emergency room visits or inpatient stays? Or if it will spread out over time.

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